=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033471867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL VALLEY RADIATION ONCOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2012
-----------------------------------------------------
Last Update Date | 06/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 SPANOS CT
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95355-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-823-1609
-----------------------------------------------------
Fax | 209-823-1655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 SPANOS CT
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95355-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-823-1609
-----------------------------------------------------
Fax | 209-823-1655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AMARJIT S. DHALIWAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 209-529-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0203X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------